三维超声测量胎盘体积预测胎儿α~0-地中海贫血  

Three-dimensional Ultrasound Measurement of Placental Volume in the Prediction of Fetal α~0-thalassemia

作　　者：陈敏[1,2] 梁国贤[1] 李之朋[1] 林勇行 唐海燕 赵德鹏[4] 刘丹[4] 何柏松[1] 

机构地区：[1]香港大学玛丽医院妇产科 [2]上海市第一妇婴保健院影像诊疗科,上海200040 [3]香港赞育医院产前诊断与咨询科 [4]同济大学医学院,上海200040

出　　处：《中国产前诊断杂志（电子版）》2010年第4期17-23,共7页Chinese Journal of Prenatal Diagnosis(Electronic Version)

摘　　要：目的探讨三维超声测量胎盘体积预测胎儿纯合型α0-地中海贫血(Hb-Bart’s病)的应用价值。方法在2002年6月～2004年5月期间对孕9～12周有α0-地中海贫血风险的胎儿组和正常对照组的单胎妊娠进行前瞻性研究。受累胎儿指二维超声检查提示α0-地中海贫血,并通过DNA检测证实的胎儿。胎盘体积通过三维超声扫描技术测量。同时评估操作者内和操作者间的测量结果的一致性。比较受累胎儿和正常对照组的胎盘体积-头臀长比值。结果最终研究对象包括105名孕妇,其中43名为α0-地中海贫血高危组,62名为正常对照组。有11名(10.5%)胎儿确定患有α0-地中海贫血,均来自高危组,其余均为正常胎儿。三维超声测量胎盘体积的操作者内和操作者间的测量结果一致性相对较差,这主要表现在一致性的变异范围较大(-10.82～40.86mL)。受累妊娠组的胎盘体积-头臀长比值的平均值±标准差(1.37±0.65)大于未受累妊娠组(1.13±0.39),但这个差异无统计学意义(P>0.05)。结论在孕早期通过三维超声测量胎盘体积来预测α0-地中海贫血并不优于二维超声。Objective To evaluate the use of placental volume measured by three-dimensional(3D)ultrasound in predicting fetal homozygous α0-thalassemia(Hb-Bart's disease).Methods From June 2002 to May 2004 singleton pregnancies at risk of α0-thalassemia and normal controls were studied prospectively at 9-12 weeks of gestation.Affected fetuses were suspected to have α0-thalassemia by two-dimensional(2D)ultrasound and confirmed by DNA analysis.Placental volume was measured on 3D ultrasound by a multiplanar technique.Intra-and interobserver agreement of measurements was assessed.The placental volume/crown-rump length quotient of the affected fetuses was compared with that of normal fetuses.Results The final study group comprised 105 pregnancies;43 were at risk of α0-thalassemia and 62 were normal controls.Eleven(10.5%)fetuses were affected by α0-thalassemia,all from the at-risk group,and the others were normal.Intra-and interobserver agreement of volume measurement by 3D ultrasound was relatively poor;this was reflected in the wide limits of agreement,which ranged from-10.82 to 40.86 mL.The mean ± SD placental volume/crown-rump length quotient in affected pregnancies was larger than that in unaffected pregnancies(1.37 ± 0.65 vs.1.13 ± 0.39),but this difference was not significant(P > 0.05).Conclusion Assessment of placental volume by 3D ultrasound does not seem to be superior to 2D ultrasound in the first-trimester prediction of α0-halassemia.

关 键 词：胎儿贫血 Hb-Bart’s病 纯合型α0-地中海贫血 胎盘 三维超声 体积 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]